Breast Health

Low Vitamin D a Problem for Women with Breast Cancer

Women with breast cancer who have a vitamin D deficiency at the time of diagnosis are more likely to have a recurrence or to die from their disease, say researchers at an American Society of Clinical Oncology (ASCO) meeting.

Surprisingly, the researchers also found that only 24 percent of the patients had adequate levels of vitamin D when they were diagnosed.

"This study found that vitamin D deficiency is very common among women with breast cancer, and it suggests that vitamin D deficiency is linked to poorer outcomes in these women," says Dr. Nancy Davidson at the Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland.

Optimal Bone Health Requires Vitamin D

Nevertheless, the evidence is not strong enough to suggest women with breast cancer take more of the vitamin.

"It's premature to tell all women diagnosed with breast cancer that they should take vitamin D supplements over and above what's recommended for bone health," says study author Dr. Pamela Goodwin at Mount Sinai Hospital in Toronto, Ontario, Canada.

"If you're a woman with breast cancer, it's probably worthwhile having vitamin D levels checked,” she notes.“If they're deficient, they should take more to get it in the range that we think is beneficial.”

The optimal levels of vitamin D associated with breast cancer risk in this study do overlap with optimal levels for bone health, adds Dr. Goodwin.

Prior research has suggested that vitamin D levels may be associated with breast cancer risk, an idea that is biologically plausible.

There is, however, a lot of confusion about the different health benefits of vitamin D and, the authors say, daily allowance recommendations vary greatly around the world.

The study involved 512 women newly diagnosed with localized breast cancer (confined to the breast and arm pit) between 1989 and 1995. All participants had had blood taken at the time of diagnosis and had also filled out a questionnaire on diet. Vitamin D levels were measured by radioimmunoassay.

The women, whose age averaged about 50, were followed for just under 12 years. Of the total, 37.5 percent were deficient in vitamin D (the lowest levels), 38.5 percent had insufficient levels of vitamin D (not deficient but not quite healthy levels), and 24 percent had levels in the healthy range.

Women who were premenopausal, weighed more, had high insulin levels, and had more aggressive tumors were all more likely to have low vitamin D levels.

"Fat tissue acts as a trap for vitamin D," says Dr. Goodwin. "Levels were also lower in younger women, which was a bit of a surprise, until we realized older women were taking more supplements."

The risk of breast cancer spreading was almost double in women with deficient levels of vitamin D at diagnosis, compared with women whose levels were healthy.

The risk of dying of breast cancer was 75 percent higher in women with too-low levels of vitamin D versus women in the optimal range.

However, there was no survival difference between women with healthy levels and insufficient levels.

Know Your Levels and What Is Right for You

The data also suggested that there may be a small increased risk of metastasis or death if vitamin D levels are high, but not a statistically significant effect, says Dr. Goodwin.

"This suggests that there's a healthy level for vitamin D and, if you are deficient, you have an increased risk of metastasis, but if you go above [a certain point], your risk of death goes up again," she says.

Although it is not a firm conclusion, Dr. Goodwin adds, the finding "is raising a red flag. It's probably not safe to take very high levels and get vitamin D levels up really high."

And the findings are consistent with another study which found that men with prostate cancer who took vitamin D died earlier than those taking a placebo.

Always consult your physician for more information.

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August 2008

Preventive Care

Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts or cysts, are often discovered during routine care.

Breast cancer is the most common type of cancer among women in the US, other than skin cancer.

According to the National Cancer Institute (NCI), when breast cancer is found early and is still localized (restricted to the site of origin, without evidence of spread), the relative survival rate, when measured at five years, is 98 percent.

When breast cancer is found at a late stage (cancer that has spread to distant parts of the body), the survival rate at five years is 26 percent.

Although the incidence of breast cancer is beginning to decrease, one out of eight women will develop invasive breast cancer at some point in their lives. Mortality rates have decreased over the past several years due to early detection and improved treatment.

If you are diagnosed with breast cancer, the most important thing for you to remember is that it is not a hopeless condition. Early detection and modern therapy with a combination of surgery, radiation, medications, or hormones can help many patients.

Step 1. Breast Self-Examination (BSE)
A woman should begin practicing breast self-examination by the age of 20 and continue the practice throughout her life - even during pregnancy and after menopause. BSE should be done regularly at the same time every month. Regular BSE teaches you to know how your breasts normally feel so that you can more readily detect any change. Changes may include:

development of a lump

a discharge other than breast milk

swelling of the breast

skin irritation or dimpling

nipple abnormalities (i.e., pain, redness, scaliness, turning inward)

If you notice any of these changes, see your healthcare provider as soon as possible for evaluation.

Step 2. Clinical Examination
A breast examination by a physician or nurse trained to evaluate breast problems should be part of a woman's physical examination.

The American Cancer Society (ACS) recommends between the ages of 20 and 39, women should have a clinical breast examination by a health professional every three years.

After age 40, women should have a breast examination by a health professional every year. A physical breast examination by a physician or nurse is very similar to the procedures used for breast self-examination. Women who routinely practice BSE will be prepared to ask questions and have their concerns addressed during this time.

Step 3. Mammography
Mammography is a low-dose x-ray of the breasts to find changes that may occur. It is the most common imaging technique. Mammography can detect cancer or other problems before a lump becomes large enough to be felt, as well as assist in the diagnosis of other breast problems. However, a biopsy is required to confirm the presence of cancer.

According to the National Cancer Institute, women in their 40s and older should begin having a screening mammogram on a regular basis, every one to two years. But, the American Cancer Society recommends that by age 40, women should have a screening mammogram every year. (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram.)

Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age.